Steps for Working With Delusions

Working with delusions is similar to hallucinations, except that more non-verbal techniques are required. You will need to sit in silence longer and with more patience, as delusions do not tend to go away, ever. The person may not verbally express them as often, but they are usually omnipresent.

1. Establish a trusting, interpersonal relationship

Do not reason, argue, or challenge the delusion. Attempting to disprove the delusion is not helpful and will create mistrust.

Assure the person that they are safe and no harm will come.
Do not leave the person alone – use openness and honesty at all times.

Encourage the person to verbalize feelings of anxiety, fear, and insecurity – offer concern and protection to prevent injury to themselves or others.

Convey acceptance of the need for the false belief.

Focus on building a trusting relationship with the person, rather than the need to control their symptoms – remain calm.

2. Identify the content and/or type of delusion

Empathize with the person and try to understand the purpose behind the delusion.

Paraphrase what the person is saying or trying to say to clarify any confusion about the delusion they are describing.

Without agreeing or arguing, question the logic or reasoning behind the delusion. For example: “If the CIA are harassing you, who is the contact person?”

Do not confirm or feed into the delusion by asking questions about it when the person is not in psychosis. For example: NEVER ask, “How’s the CIA today?” when the person is well.

Identify what might be the central topic.

Identify the main feeling and/or tone of the delusion.

3. Investigate how the delusion is affecting the person's life

Assess if and how the delusions are interfering with a person’s life. For example, are they are no longer able to function or participate in regular everyday life?

Assess if the delusion is affecting a person’s relationship with others.

Determine if the person has taken action based on their delusion.

4. Assess the intensity, frequency, and duration of the delusion

Keep a log documenting the intensity, frequency, and duration of a person’s delusion.

Determine if their delusions tend to occur at a certain time of day or are related to certain activities or actions. This can help you look for ways to avoid situations that may trigger paranoia or delusions.

Some delusions are fleeting and brief, while others are more long lasting and endure over a long period of time.

5. Attempt to redirect or distract the person from their delusion

Does the person always greet you with the delusion? If so, just quietly listen and then give direction for the task at hand.

If it appears that the individual cannot stop talking about the delusion, ask gently if they recalls what you have been doing and that it’s time to resume that activity.

If the person is very intent upon telling you the delusion, just quietly listen until there is no need to discuss it any further.

Remember that it is helpful to give the person reassurance during the delusion that they, as a person, are okay.

Ways to cope with someone who has delusions

Try to offer empathy and focus on the emotions that the person is experiencing. Arguing facts and details may cause the person to shut down and perceive you as judging them. By offering support with no judgement that doesn’t confirm or deny the delusion, the person may feel consoled and trust that you care for them. Some things to keep in mind as you speak to the person:

1. Pay attention to the emotions of the person

2. Discuss the way you see the delusion

3. Express that you are concerned about the person

4. Offer to pursue therapy together but be strategic

5. Ask the person why they believe as they do and be open-minded

6. Avoid getting frustrated and expressing that to the person

7. Learn about Cognitive Distortions or Thinking Errors

8. Model engagement in reality testing

Information for these strategies are from Tamara Hill’s article on PsychCentral, an independant mental health website with information and content overseen and created by mental health professionals.